Inpatient Service

INPATIENT SERVICE 

• Rounds to start every morning @ 9 AM with ICU team 

**EVERY Patient (ICU + Floor pts) should have a Fellow Note**

• • On ICU consults (from the MICU),  there is a Cardiology Fellow note only (no intern or resident note) – so make it extra good!

  • Does not have to be long, but should contain the essentials.  For instance:

    • If CHF:  Should list out their cardiac medications and the specific recommendations of the day (ie increase Coreg to 25 or Start Lasix 40 mg IV x 1)

    • When staff writes, “Please see note for details” – your note should contain specific details on the recommendations

• • If Applicable, the patient’s coronary anatomy should be documented

  • Rather than say, “They had PCI in 2008” – there should be documentation of what their cardiac anatomy is.  A cardiologist should be more specific in their documentation

• DiSCHARGING SOMEONE ON PLAVIX

  • It is the fellows job to make sure they get their Plavix.  

  • Be sure that when Rx’ing Plavix:

    • Window pickup;  90 days supply with 3 refills

  • If they are on medicine service and medicine is discharging, it is still the fellows responsibility to make sure above is done and to write for the Plavix 

  • In EMR::  Cardiology (left hand side menu) ” Meds:  Clopidogrel 75 mg…”

• BEFORE AN EP PROCEDURE

  • Ensure that they are NPO except medications after midnight

  • No Lovenox or Heparin after midnight

  • Can pass the 30 minute lying flat in bed without dyspnea test

-If they can not lay flat for 30 minutes without getting SOB,  they are at HIGH  risk of complications and case should be cancelled

• CONSENTS

  • If consenting EP procedures, please see Consent Section 

  • If consenting for any cardiology procedure (TEE, DCCV, Cath, PCI, Pericardiocentesis) – please include ALL cardiology attending names 

**The names of Any and All Fellows as well as residents/interns that might be in the case must be on the consent***

-That means, if there is a resident who is rotation through cardiology and is observing in the lab --> that resident's name must be on consent

JOINT COMMISSION REQUIREMENT:  the names of all staff **including students** involved in performing the procedure must be included on the written consent.

• HOW TO ORDER A CARDIAC MRI  [please help your staff fill this out, as it has to be staff]

  • In CPRS, under the NOTES tab, click on ACTION NEW PROGRESS NOTE type in “MRI Checklist” and then fill in 

    1. Under Clinical history enter in:  For Cardiac MRI” and then add the reason, then comment “Cardiac MRI unavailable at CTX VA”

    2. Use appropriate ICD 10 Code or request will be cancelled 

    3. Radiology staff will review and forward to community care and then MRI will be scheduled by community care staff 

• CHECK OUT WITH HOUSE OFFICER

  • Check out with house officer EVERY day at the time you physically leave the hospital 

  • Even if there are no cardiology primaries, please disclose this to the house officer

  • There is a mistaken believe that the H.O does not cover cardiology patients, which is completely 100% false.  Repetition every day will help reinforce this and save you phone calls in the future

• FOLLOW UPS

  • Not everyone needs post follow up

  • If you are having them follow up in the clinic, on your FELLOW note, please specify what you would like for them to do in their clinic follow up

    • IE:  Assess for Chest pain, and if chest pain refractory to 2 different anti-anginals, then do XYZ or Titrate up medical therapy by adding Entresto etc

  •  Look through CPRS and see if the patient is followed regularly in our clinic

-They might already have an existing cardiology appointment 

• • For patients who are stable, are regularly followed in the cardiology clinic, and can wait > 6 weeks to see their regular cardiology clinic follow up in their regular clinic 

  • For a SPECIFIC EP Procedure (ie – they already meet criteria for an ICD, or flutter / PSVT ablation)

    • Please contact EP Attending PRIOR to scheduling anything

    • If you put a new onset Afib patient to follow up in the EP attending's clinic, expect to come in that scheduled day (Monday afternoon) and see that patient in clinic and write a note.  If you can not personally come that day, then plan to make arrangements with another fellow to cover you